Treatment of Femoral Neck Fractures with Cannulated Screw Invasive Internal Fixation Assisted by Orthopaedic Surgery Robot Positioning System

摘要

Objective To investigate the clinical efficacy and advantages of cannulated screw internal fixation assisted by the orthopaedic surgery robot positioning system in the treatment of femoral neck fractures. Methods The clinical data of 128 patients with femoral neck fractures which had been treated with cannulated screw internal fixation from January 2016 to July 2018 were retrospectively analyzed. Among them, 63 patients were treated with cannulated screw assisted by orthopedic robot positioning system (orthopaedic surgery robot group), and 65 patients were treated with traditional cannulated screw (traditional surgery group). The operation time, number of intraoperative fluoroscopy, number of guide needle placements, and the amount of operative blood loss were compared between the two groups. The success rate of one‐time nail placement and the fracture healing rate were calculated. Fracture healing and internal fixation were observed. The hip joint function was evaluated by the Harris hip score 1?year after operation. Results All patients were followed up for 12 to 24?months. The operation time was 65.70?±?9.87 min in the robot group and 73.74?±?9.78 min in the traditional group. The number of intraoperative fluoroscopy was 13.67?±?4.39 times in the robot group and 17.09?±?4.02 times in the traditional group. The number of guide needle placements was 9.95?±?3.72 times in the robot group and 13.78?±?4.39 times in the traditional surgery group. The success rate of one‐time nail placement was 100% (63/63) in the robot group and 49.23% (32/65) in the traditional group. The amount of operative blood loss was 15.25?±?6.21 mL in the robot group and 25.51?±?6.97 mL in the traditional group. Compared with the traditional group, the robot group had shorter operation time, less fluoroscopy, less needle placement, less bleeding, and higher success rate of one‐time nail placement. There was a significant difference between the two groups ( P ?0.05). In the robot group, there was no infection, loosening of internal fixation, fracture displacement, and osteonecrosis of femoral head during the follow‐up period. The fracture healing rate was 100% (63/63). In the traditional group, there were two cases of loosening of internal fixation and one case of osteonecrosis of femoral head during the follow‐up period. The fracture healing rate was 100% (65/65). All patients were evaluated for hip joint function 1 year after operation. The Harris hip score in the robot group was 86.86?±?4.74, and the Harris hip score in the traditional surgery group was 83.08?±?5.44. Compared with the traditional group, the Harris hip score in the robot group was higher than that in the traditional group. There was significant difference between the two groups ( P ?0.05). The excellent and good rate were 92.06% (58/63) in the robot group and 80% (52/65) in the traditional group. There was no significant difference between the two groups ( P ?0.05). Conclusion Cannulated screw internal fixation assisted by the orthopaedic surgery robot positioning system is an ideal method for the treatment of femoral neck fractures. This method has the advantages of relatively simple operation, more accurate screw placement during operation, high success rate of one‐time nail placement, short operation time, less surgical trauma, less radiation, and good recovery of hip function.